Lifespan and associated factors of peripheral intravenous Cannula ...

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The insertion of a peripheral intravenous cannula in newborn infants can be difficult. Appropriate veins ... Intravenous (IV) therapy relates to the administration of.
Birhane et al. BMC Nursing (2017) 16:33 DOI 10.1186/s12912-017-0227-1

RESEARCH ARTICLE

Open Access

Lifespan and associated factors of peripheral intravenous Cannula among infants admitted in public hospitals of Mekelle City, Tigray, Ethiopia, 2016 Eskedar Birhane1*, Kalayou Kidanu2, Mekuria Kassa2, Dawit Gerezgiher1, Lidia Tsegay1, Brhanu Weldu3, Genet Kidane4 and Hadgu Gerensea1

Abstract Background: Peripheral Intravenous cannula (IV) is the most common vascular access device used to administer medications with the exception of medication or fluid with high or low PH or hyperosmolarity which may cause severe damage to small veins. The insertion of a peripheral intravenous cannula in newborn infants can be difficult. Appropriate veins with sufficient capacity to insert a cannula become less available throughout the hospital stay. Once a peripheral intravenous cannula is inserted, it is desirable that its patency can be maintained as long as possible. This study was aimed to assess the lifespan and associated factors of peripheral intravenous cannula among infants admitted in public hospitals of Mekelle city, Tigray, Ethiopia, 2016. Methods: The method used was a prospective cohort study. 178 study subjects were recruited using systematic random sampling technique. The data was collected by structured questionairre and observational checklist. Results: More than half of infants (94) had a short cannula lifespan (below 30 h). Multivariable logistic regression analysis showed that Pediatric intensive care unit (PICU) [AOR = 6.93; 95% CI (1.56,30.71)], clinical experience (3-5 years) [AOR = 0.168; 95% CI (0.060-0.469)], insertion site (arm) [AOR = 0.126;95% CI (0.046-0.349)], reason for removal (dislodgement and complication) [AOR = 8.15; 95% CI (2.49,26.63) [AOR = 10.48;95% CI (3.08,35.65)], medication [AOR = 0.17;95% CI (0.37,0.784)], corticosteroids [0.164; 95% CI (0.034,0.793)] and blood transfusion [AOR = 0.12; 95% CI (0.028-0.509)] were the statistically significant variables associated with the lifespan of a peripheral intravenous cannula. Conclusions: Untimely removal of peripheral intravenous cannulas was higher in infants and demographic. Cannulation and health care factors had significant effects on the lifespan of a peripheral intravenous cannula. Keywords: Lifespan, Associated factor, Peripheral intravenous cannula, Infant

Background Intravenous (IV) therapy relates to the administration of therapeutic solutions directly into a vein. Compared with other approaches such as intramuscular injection, intravenous (IV) therapy is the fastest and most reliable way to deliver fluids or medications [1]. With more than 90% of hospitalized patients requiring IV therapy, the * Correspondence: [email protected] 1 School of Nursing, College of Health Sciences and Referral Hospital, Axum University, Axum, Ethiopia Full list of author information is available at the end of the article

proportion of patients requiring infusion devices has increased significantly over the past 30 years. IV therapy, which has multiple indications, can maintain the fluid and electrolyte balance of the body, infuse medications, transfuse blood or blood components and provide some nutritional support such as total parenteral nutrition [2]. The lifespan of a peripheral intravenous cannula is an important issue, and its survival depends on many variables, including the size, frequency of usage, methods of administration of medications and fluids, and others. It is noticed that when certain drugs are administered, the

© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Birhane et al. BMC Nursing (2017) 16:33

peripheral intravenous cannula is infiltrated faster. Factors affecting the life span of peripheral intravenous cannula have been studied in newborns and infants [3, 4]. Heparin and limb splinting have been used in an attempt to prolong duration of the peripheral intravenous cannula [5, 6]. Although peripheral intravenous cannulas are routinely used in hospital admitted infants, the risk of complications remains high. Non-elective removal of a peripheral intravenous cannula as a result of complications occurs in up to 78% of insertions and can lead to untimely removal of up to 95% of the devices [7]. It is difficult to ascertain precise complication rates due to a lack of consistent definition for complications, significant variation in reporting among different facilities, and studies focused on specific complications. Routine replacement of peripheral intravenous cannulas is not recommended in neonates given challenges associated with their small, fragile veins and limited vascular access [8, 9]. Peripheral intravenous cannulas that are left in situ when they are no longer required may predispose the patient to intravascular infection. There is also emerging evidence that the regular refitting of peripheral intravenous cannulas as a strategy to reduce intravascular infection provides no protective benefit, and if removed when clinically indicated, can avoid millions of cannula insertions which can substantially reduce health care costs and improve patient satisfaction [10]. The average lifespan of peripheral intravenous cannulas in neonates and infants reported in the literature ranges from 15 to 54 h and 12 to 274 h respectively. Cannulas can be safely maintained with adequate monitoring for up to 144 h in critically ill children [11, 12]. Accessing the vascular system necessitates penetration of the skin and stabilization of the cannula in situ. The lifespan of peripheral intravenous cannula and its survival depends on many factors, including the size cannula, frequency of usage, methods of administration of medications, increased number of attempts at placement of intravenous cannulas, fluids and others [3, 4]. Insertion of peripheral intravenous cannulas is a painful procedure for infants, therefore, identifying which factors affect the lifespan of a peripheral intravenous cannula will help reduce complications and increase duration of cannula patency. Additional issues that must be considered include the potential for prolonged hospital stay as a result of cannula-associated complications, delays in therapy, and the impact on patient/family satisfaction. Thus, reducing complications will lead to a reduction in downstream activity, as well as the time associated with the reassessment of a failed peripheral intravenous cannula, reducing additional supplies for the peripheral intravenous cannula replacement, and reducing the risk of needle stick injury.

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This study evaluates the lifespan of peripheral intravenous cannulas in infants and identifies factors which affect the lifespan of peripheral intravenous cannula that contribute to the current knowledge regarding intravenous practices in infants.

Methods The study was conducted in Mekelle, Ethiopia, an area with two governmental hospitals and three private hospitals. Ayder Hospital, a major referral and teaching hospital in the Tigray region, opened in 2007 with 500 beds, serving 32,000 patients. The second, Mekelle Hospital, a regional referral and teaching hospital, was established in 1962 with 162 beds and a total annual flow of 4276 patients. The study period spanned from October, 2015 to May, 2016. The study design was an institutional based cross-sectional study design. Sample size determination and sampling procedures

A total of 178 samples were employed among the two hospitals using systematic random sampling. Data collection procedure and tool

Data was collected by observational checklist and structured questionnaire. Continuous follow up and supervision by the supervisors and principal investigators occurred throughout the data collection period. Data quality assurance, entry and analysis

The data was recorded, cleaned and analyzed using Statistical Package for Social Sciences (SPSS) version 20 software statistical packages. Frequencies and proportions were used to describe the study population in relation to relevant variables. Logistic regression was computed to assess statistical association via calculating Crud Odds and Adjusted odds ratio to see the influence of independent variables on dependent variables, and significance of statistical association was assured or tested using 95% confidence interval and P-value (15

11 (6.2)

06

05

0.767 [0.219,2.69]

0.313 [0.049,1.99]

No

37

21

16

1

Yes

141 (79.2)

73

68

0.818 [0.394,1.69]

No

161 (90.4)

88

73

1

1

Yes

17 (9.6)

06

11

0.452 [0.16,1.283]

2.36 [0.554,10.046]

No

161 (90.4)

89

72

1

1

Yes

17 (9.6)

05

12

0.337 [0.113,1.00]

0.164 [0.034,0.793] **

1

73 (41)

36

37

0.924 [0.488,1.75]

2-3

78 (43.8)

40

38

1

4-6

27 (15.2)

18

09

1.90 [0.761,4.744]

*P value